Rupture of the right hemidiaphragm due to blunt trauma in children: a diagnostic dilemma

Abstract

The diagnosis of right-sided diaphragmatic rupture (RDR) due to blunt abdominal trauma is often missed in the acute setting, especially in the absence of other thoracoabdominal injuries. We describe two such children. The problems associated with the diagnosis and management of RDR are discussed to emphasize the need to have a high index of suspicion for this entity.

Late Presentation of a Traumatic Rupture of the Diaphragm with Gastric Volvulus in a Child: Report of a Case

“…In some cases, the diaphragm is devitalized at the time of the initial injury and eventually is weakened by the infl ammatory process with the resultant herniation. 2,5,8,9 These events may occur either immediately or months after the initial injury, as observed in our case. 2,3,5-8 Herniation of the abdominal contents may result in the obstruction and strangulation of the herniated visera.…”

“…In children, the chest wall is more compliant and the mediastinum is more mobile than in adults. 2,5,9 Therefore, TDR may become evident only after the herniation of abdominal contents into the chest. In some cases, the diaphragm is devitalized at the time of the initial injury and eventually is weakened by the infl ammatory process with the resultant herniation.…”

“…A delayed presentation can lead to lifethreatening complications as a result of organ herniation, strangulation, and respiratory compromise. 2,3,[5][6][7][8][9][10] Late presentation is relatively common in adults but rare in children. Because of anatomic and physiologic differences, TDR may be even more diffi cult to diagnose in children than in adults.…”

“…[1][2][3][4] This type of injury is usually associated with major trauma and multiple organ involvement, and, it is often shadowed by the severity of the associated injuries and therefore may consequently be overlooked. 2,3,[5][6][7][8][9][10] The diagnosis is often diffi cult, and a delay in diagnosis may result in an increased mortality and morbidity. A delayed presentation can lead to lifethreatening complications as a result of organ herniation, strangulation, and respiratory compromise.…”

Traumatic right diaphragmatic hernia in children: Diagnostic difficulties

“…It is usually a congenital, but many cases of traumatic origin have been described in children. [ 1 2 ] Traditionally, diaphragmatic ruptures were considered to be more frequent on the left than the right. Previously, it was the belief that the buffering effect played by the liver and right kidney is responsible for the relative lack of involvement of the right hemi-diaphragm.…”